Sharp enteritis – an acute infectious disease with involvement in pathological process of a small intestine which can be caused by bacterial flora, viruses, the elementary. In a clinical picture symptoms of dehydration prevail; vomiting, diarrhea is characteristic; the intoksikatsionny syndrome is possible. Diagnostics includes performing laboratory blood tests, koprogramma, a microbiological research of excrements, serological methods. The main direction of treatment is adequate rehydration therapy; at indications antibacterial medicines are appointed. The forecast is defined by a type of the activator and timeliness of treatment.
Sharp enteritis – one of forms of sharp intestinal infection; seldom meets in the isolated look, a thicket in combination with gastritis or colitis. This pathology keeps relevance in connection with universal prevalence, risk of development in a number of patients of life-endangering states, growth of number of the diseases caused by obligate pathogenic flora, and also a possibility of intrahospital distribution with formation of stability to etiotropny medicines. In developing countries with sharp enteritis about 3 billion patients a year get sick, about 3 million from them perish. With an identical frequency sharp enteritis is diagnosed for persons of both floors, children suffer more often; essential growth of incidence is noted during the summer period. In structure of infectious pathology at children's age sharp enteritis takes the second place on frequency after ORZ.
Reasons of sharp enteritis
Infection with bacteria (causative agents of dysentery, salmonellosis and iyersinioz, klostridiya, enterotoksigenny strains , a kampilobakter, staphylococcus, a sinegnoyny stick and other bacterial agents) or viruses (rotaviruses, reovirusa, adenoviruses) is the reason of development of sharp enteritis. Less often virus and bacterial or bacterial and bacterial mikst-infections, protozoan defeats are registered.
The etiopatogeneza of sharp enteritis is the cornerstone inflammatory process in a small intestine, development of dehydration at the expense of endotoxicosis with hyper secretion of water and electrolytes and violations of absorption of liquid in intestines. Mechanisms of pathogenesis of sharp enteritis are defined by type of the activator and way of overcoming antimicrobic protection. The microorganisms which got to a gleam of a small intestine by means of adhesion colonize it and actively breed, despite a vermicular movement and antimicrobic resistance. As a result of an invasion acute inflammatory reaction and as a result – death of cages of an epithelium begins the activator of a mucous membrane. Many bacteria and viruses have ability to produce the enterotoksina stimulating system of an adenilattsiklaza and causing active secretion of liquid in an intestines gleam.
Symptoms of sharp enteritis
Sharp enteritis in most cases develops violently. Owing to loss of a large amount of liquid at diarrhea and vomiting the condition of the patient for the short period of time can significantly worsen. The incubatory period lasts from one-two hours to several days. Most often the first and the symptom defining severity is diarrhea. Nausea, vomiting are also characteristic. For bacterial sharp enterit the expressed intoksikatsionny syndrome; the hyperthermia (to 38-39 °C), the general weakness, dizziness is possible. As many bacteria have ability to produce the cytotoxins causing death of cages of an epithelium of an intestinal wall, the disease can proceed with the expressed pain syndrome (spastic pains on the intestines course disturb). Sharp enterita of a virus etiology seldom are followed by pain, however the respiratory syndrome is typical (a nose congestion, ).
The main clinical symptom of sharp enteritis which defines the course of a disease and demands urgent correction is dehydration. The first degree of dehydration is characterized by loss no more than three percent of body weight, at the same time the general condition of the patient satisfactory. At sharp enterita the frequency of a chair can reach 10 times a day and more, in such cases loss of liquid makes 5-6% of body weight (the second degree of dehydration). At dehydration of the third degree (loss to 9%) the condition of the patient significantly worsens; spasms, an aphonia, a lowering of arterial pressure, an anury, decrease in body temperature to 35 ° are possible. Dehydration of the fourth degree (10% and more) is characterized as gipovolemichesky shock.
Diagnosis of sharp enteritis
The most informative method of diagnosis of sharp enteritis is the microbiological research of excrements with identification of the activator. This method allows to establish precisely an etiology of a disease and to pick up the optimum scheme of treatment. However performance of this research requires several days, and the result is delayed. For this reason the important part is assigned to full collecting the anamnesis of a disease, assessment of an epidemiological situation in the concrete region, to identification of the diseased among an inner circle. Definition like diarrhea (invasive, sekretorny, osmotic) allows to assume a possible etiologichesky factor of sharp enteritis and to approach differentially the beginning of therapy.
At survey of the patient symptoms of dehydration of various degree of expressiveness come to light: dryness of integuments, decrease in turgor of skin, pallor, dryness of language, the lowering of arterial pressure, heartbeat increase is possible. Changes of results of laboratory analyses are characteristic: is defined , acceleration of SOE, at heavy dehydration – reduction of a liquid component of blood in relation to uniform elements (haemo concentration). The koprologichesky research is carried out: in excrements slime, blood, pus, abundance of undigested cellulose and muscle fibers can be found. Serological diagnostics is surely carried out: the quadruple gain of a caption of specific antibodies allows to define activator type precisely.
Treatment of sharp enteritis
Treatment of sharp enteritis can be carried out on an outpatient basis; hospitalization is carried out to infectious office at considerable dehydration, neurologic violations (spasms, slackness and others), shock, unrestrained vomiting, aged to 3 months, at impossibility of carrying out an oral regidratation, and also the expressed pain syndrome and suspicion of surgical pathology.
The main directions of treatment of sharp enteritis are the adequate regidratation, a dietotherapy and antibiotic treatment (if necessary). From the first days of a disease the amount of food has to be reduced by 30% in comparison with habitual. All products causing the raised osmotic load of intestines are excluded.
Priority action at sharp enteritis of any etiology – rehydration therapy. Its early beginning is the main criterion of successful treatment. At dehydration 1-2 degrees are carried out an oral regidratation; salt medicines are for this purpose applied. At the first stage compensate water-salt deficiency (restore the waters and electrolytes lost during a disease). The intensive regidratation is carried out within 5-6 hours. After elimination of symptoms of dehydration the supporting rehydration therapy continues. Even at absence at the patient of symptoms of dehydration oral salt medicines apply for the purpose of its prevention.
Antibacterial therapy of sharp enteritis is shown in case of a bacterial etiology in the presence of such indications: age of the patient up to three months, immunodeficiency (HIV infection, performing immunosupressivny therapy, long reception of corticosteroids), the heavy invasive diarrhea (about this form testifies availability of blood in excrements, identification in a koprogramma of neutrophils) verified cholera or and also suspicion on these etiologichesky factors. As empirical antibacterial therapy of sharp enteritis derivatives of nitrofurans are applied; after obtaining results of a bacteriological research with the analysis to antibiotics appoint the most suitable medicine to sensitivity (tsefiksy, , trimetopry + , , and others).
In most cases the adequate regidratation and antibiotic treatment (at a bacterial etiology) provide an absolute recovery. Besides these methods of treatment, supportive applications are applied. Purpose of probiotics allows to improve results of treatment, and in some cases at sekretorny diarrhea this group of medicines acts as the main method of treatment. For the purpose of reduction of losses of liquid, and also acceleration of removal of microorganisms and enterotoksin enterosorbents are used (silicon medicines are most effective).
Forecast and prevention of sharp enterit
The forecast at sharp enteritis is defined by activator type, and also the timely beginning of effective therapy. In the absence of heavy dehydration the forecast favorable. Independent treatment of sharp enteritis can lead not only to a long absence of effect, but also to formation of chronic inflammatory process with development of other diseases. The adverse forecast at sharp enteritis is possible with such risk factors as age up to six months and after 65 years, the accompanying heavy somatic pathology (neurologic, cardiovascular diseases, an oncopathology and others).
Prevention of sharp enteritis consists in observance of rules of hygiene, careful mechanical, heat treatment of food, detailed inspection of employees of the food industry with their discharge from work in the presence of infectious diseases. The important part is assigned to also timely treatment of diseases of digestive tract at the gastroenterologist (in particular, the lowered acidity of gastric contents is risk factor of development of intestinal infections).